Provider Demographics
NPI:1639881113
Name:BAEZ MENDEZ, EVELYN (TO)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BAEZ MENDEZ
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:BAEZ MENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TO
Mailing Address - Street 1:RR 5 BOX 9160
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9215
Mailing Address - Country:US
Mailing Address - Phone:787-317-6682
Mailing Address - Fax:
Practice Address - Street 1:115 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4780
Practice Address - Country:US
Practice Address - Phone:787-317-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist